Mark Wilson gives handy hints on organising an elective in Uganda
Uganda, a former British colony, has had relatively good economic growth since democracy in 1986. It is still a very poor country, however, and in the north problems with rebel attacks and ambushes prevail. HIV, malaria, and tuberculosis are all very common.
Medicine
HIV infection is a major problem, although recent data show a reduction in the prevalence in pregnant women. About 1.5 million people in the country are thought to be HIV positive. Prevalence can reach 30% in some city areas. In rural areas it can be 15%, so always be very careful and use universal precautions when doing procedures. As of 2000, 55 000 cases of AIDS have been reported. The ratio of male to female cases is 1:1.2.1
Other common conditions are tuberculosis, malaria, measles, trauma, and gastrointestinal infections. Child health (especially immunisation), disease surveillance, and public health are all receiving high priority. The national health research organisation in Uganda oversees research units specialising in viruses, cancer, tuberculosis, public health, trypanosomiasis, and cardiology (see www.health.go.ug).
The healthcare system
Uganda has 104 hospitals, 57 of which are run by the government, 44 by non-governmental organisations, and three are private. In addition there are 250 health centres. The mission hospitals rely on charity, small donations from government, and small contributions from patients. Uganda has three medical schools.
Kigezi International School of Medicine: Kabale Hospital, PO Box 7, Kabale, Uganda (Tel: +256 (248) 220 06 (from the United Kingdom, dial 01 223 355 076). Fax from the United Kingdom, dial 01 223 327 292. Email: kigezi.med@dial.pipex.com).
Makerere University Medical School: Faculty of Medicine, PO Box 7072, Kampala, Uganda (Tel: +356 (41) 530 020. Fax: +256 (41) 531 091).
Mbarara University of Science and Technology: Faculty of Medicine, PO Box 1410, Mbarara, Uganda (Tel: +256 (485) 207 82/200 07).
The national referral hospitals (both government run) are:
Mulago Hospital: PO Box 7051,
Kampala, Uganda (1500 beds) (Tel: 041-541 250/533 560 Fax: 041 532 591).
Butabika Hospital, PO Box 7017, Kampala, Uganda (850 beds).
There are also regional referral hospitals with specialist fields (Arua, Gulu, Hoima, Jinja, Kabarole, Masaka, Mbale, Mbarara, and Soroti). These also act as teaching hospitals.
Some of the hospitals run by non-governmental organisations also have specialists (Nsambya, Rubaga, Mengo (Kampla district), Lacor, and Matany (Moroto district)).
Addresses for all these hospitals can be found on www.medicstravel.com under Uganda or on Uganda Health Online (www.health.go.ug).
Some mission hospitals that come highly recommended for electives include the following.
Kisiizi Hospital: PO Box 109, Kabale, Uganda (Tel: 00 871 761 587 164. Fax: 00 871 761 587 166 (this is an expensive satellite phone)). This 200 bed rural mission hospital is about an hour off the main road in south west Uganda. It is usually run by four British and Ugandan doctors and has maternity (900 deliveries per year), surgical, medical, paediatrics, special care baby unit, and isolation wards as well as two operating theatres.
Kagando Hospital: Private Bag, Kasese, Uganda. This is a 220 bed missionary hospital that also receives some government funding situated in the Rwenzan mountains in western Uganda. It usually has three physicians, a couple of surgeons, and a couple of anaesthetists. (Note: the surrounding areas have been dangerous with rebel attacks in recent years.)
Nyakibale Hospital: PO Box 31, Rukungiri, Uganda. This is a former mission hospital with around 330 beds in south west Uganda near Zaire. It has a large maternity wing and is usually run by around four Ugandan doctors. The hospital provides medical, surgical, orthopaedic, paediatric, and obstetrics and gynaecology services. HIV prevalence is around 15% in this area.
Kuluva Church of Uganda Hospital: PO Box 28, Arua, Uganda.
Masaka Hospital: PO Box 18, Masaka, Uganda.
